Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://ijcp.elmerpub.com

Original Article

Volume 14, Number 2, October 2025, pages 28-36

Determinants of Oral Health-Related Quality of Life in Children With Neurological Disorders: An Interdisciplinary Study

↓ **Table 1.** Hierarchical Poisson Regression for Impact on P-CPQ of Children and Independent Variables
Variable	Frequency n (%)	Impact on child’s OHRQoL	Bivariate	Multivariate
^aUnadjusted Poisson regression (PR) for independent variables and impact on child’s quality of life. ^bVariables incorporated in the multivariate model (P < 0.20): Caregiver bond with the child; caregiver’s age; caregiver’s education; child’s age; “Has the child ever been afraid of other children?”; “Have other children bullied or threatened the child?”; “Has the child ever felt discomfort when chewing?”; CP; ID. OHRQoL: oral health-related quality of life; CI: confidence interval; ASD: autism spectrum disorder; CP: cerebral palsy; ADHD: attention deficit hyperactivity disorder; ODD: oppositional defiant disorder; ID: intellectual disability.
Bullying
Present	103 (78.6)	98 (95.1)	5 (4.9)	0.669	1.025 (0.916 - 1.146)	-	-
Absent	28 (21.4)	26 (92.9)	2 (7.1)		1.00	-	-
Dental caries
Yes	93 (71)	88 (94.6)	5 (5.4)	0.979	0.999 (0.914 - 1.092)	-	-
No	38 (29)	36 (94.7)	2 (5.3)		1.00	-	-
Orthodontic treatment need
Yes	78 (63.4)	75 (96.2)	3 (3.8)	0.516	1.030 (0.942 - 1.127)	-	-
No	45 (36.6)	42 (93.3)	3 (6.7)		1.00	-	-
Caregiver bond
Relatives (grandmother/aunt)	21 (15.9)	21 (100)	0 (0)	0.046^a	1.041 (1.001 - 1.083)	-	-
Father	10 (7.6)	7 (70)	3 (30)	0.128	0.729 (0.485 - 1.096)	-	-
Mother	101 (76.5)	97 (96)	4 (4)		1.00
Caregiver’s age
Middle-aged or elderly adults (≥ 45 years)	40 (30.3)	39 (97.5)	1 (2.5)	0.260	1.043 (0.969 - 1.122)	-	-
Young adults (18 - 44 years)	92 (69.7)	86 (93.5)	6 (6.5)		1.00	-	-
Time spent with child
Less than 12 h a day	8 (6.1)	8 (100)	0 (0)	0.157	1.032 (0.988 - 1.077)	-	-
> 12 and < 18 h a day	59 (44.7)	54 (91.5)	5 (8.5)	0.207	0.944 (0.864 - 1.032)	-	-
≥ 18 to 24 h a day	65 (49.2)	63 (96.9)	2 (3.1)		1.00	-	-
Caregiver’s education
> High school	18 (13.6)	17 (94.4)	1 (5.6)	0.502	0.961 (0.855 - 1.080)	-	-
> Primary education to ≤ high school	55 (41.7)	50 (90.9)	5 (9.1)	0.089	0.925 (0.845 - 1.012)	-	-
Primary education or less	59 (44.7)	58 (98.3)	1 (1.7)		1.00
Family income
Equal or more than 3 minimum wages	25 (18.9)	24 (96)	1 (4)	0.317	0.960 (0.866 - 1.040)	-	-
Between 1 and less than 3 minimum wages	79 (59.8)	73 (92.4)	6 (7.6)	0.014^a	0.924 (0.867 - 0.984)	-	-
Less than 1 minimum wage	28 (21.2)	28 (100)	0 (0)		1.00	-	-
Child’s sex
Male	89 (67.4)	83 (93.3)	6 (6.7)	0.211	0.955 (0.888 - 1.027)	-	-
Female	43 (32.6)	42 (97.7)	1 (2.3)		1.00	-	-
Child’s age
Between 11 and 14 years	55 (41.7)	50 (90.9)	5 (9.1)	0.138	0.933 (0.852 - 1.022)	-	-
Between 6 and 10 years	77 (58.3)	75 (97.4)	2 (2.6)		1.00	-	-
Child’s ethnicity
Non-White (Hispanic/African)	37 (28)	36 (97.3)	1 (2.7)	0.322	1.039 (0.964 - 1.119)	-	-
White (Caucasian)	95 (72)	89 (93.7)	6 (6.3)		1.00	-	-
Child’s living arrangement
Relatives (grandmother, uncles, brothers)	20 (15.2)	20 (100)	0 (0)	0.008^a	1.067 (1.017 - 1.119)	-	-
Parents	112 (84.8)	105 (93.8)	7 (6.3)		1.00	-	-
Dental caries treatment history
Yes	75 (57.3)	72 (96)	3 (4)	0.449	1.034 (0.949 - 1.127)	-	-
No	56 (42.7)	52 (92.9)	4 (7.1)		1.00	-	-
Fear of other children
Yes	59 (45.4)	55 (93.2)	4 (6.8)	0.530	0.973 (0.895 - 1.059)	-	-
No	71 (54.6)	68 (95.8)	3 (4.2)		1.00	-	-
Experience of peer teasing
Yes	89 (70.1)	85 (95.5)	4 (4.5)	0.492	1.037 (0.935 - 1.150)	-	-
No	38 (29.9)	35 (92.1)	3 (7.9)		1.00	-	-
Experience of peer bullying
Yes	52 (40.3)	51 (98.1)	1 (1.9)	0.108	1.064 (0.987 - 1.147)	-	-
No	77 (59.7)	71 (92.2)	6 (7.8)		1.00	-	-
Orthodontic appliance use
Yes	9 (6.8)	9 (100)	0 (0)	0.008^a	1.060 (1.015 - 1.107)	-	-
No	123 (93.2)	116 (94.3)	7 (5.7)		1.00	-	-
Chewing discomfort
Yes	47 (35.9)	46 (97.9)	1 (2.1)	0.157	1.054 (0.980 - 1.134)	-	-
No	84 (64.1)	78 (92.9)	6 (7.1)		1.00	-	-
ASD
Yes	40 (30.3)	37 (92.5)	3 (7.5)	0.505	0.967 (0.876 - 1.067)	-	-
No	92 (69.7)	88 (95.7)	4 (4.3)		1.00	-	-
Epilepsy
Yes	65 (49.2)	62 (95.4)	3 (4.6)	0.728	1.014 (0.936 - 1.100)	-	-
No	68 (50.8)	63 (94)	4 (6)		1.00	-	-
CP
Yes	19 (14.4)	19 (100)	0 (0)	0.008^a	1.066 (1.017 - 1.118)	0.008^a	1.066 (1.017-1.118)
No	113 (85.6)	106 (93.8)	7 (6.2)		1.00		1.00
ODD
Yes	6 (4.5)	6 (100)	0 (0)	0.008^a	1.059 (1.015 - 1.105)	-	-
No	126 (95.5)	119 (94.4)	7 (5.6)		1.00	-	-
ADHD
Yes	35 (26.5)	33 (94.3)	2 (5.7)	0.902	0.994 (0.905 - 1.092)	-	-
No	97 (73.5)	92 (94.8)	5 (5.2)		1.00	-	-
ID
Yes	25 (18.9)	22 (88)	3 (12)	0.239	0.914 (0.787 - 1.062)	-	-
No	107 (81.1)	103 (96.3)	4 (3.7)		1.00	-	-

↓ Table 1. Hierarchical Poisson Regression for Impact on P-CPQ of Children and Independent Variables

Variable

Frequency n (%)

Impact on child’s OHRQoL

Bivariate

Multivariate

Present n (%)

Absent n (%)

Unadjusted

Adjusted

PR^a

PR^b

P value

(95% CI)

P value

(95% CI)

^aUnadjusted Poisson regression (PR) for independent variables and impact on child’s quality of life. ^bVariables incorporated in the multivariate model (P < 0.20): Caregiver bond with the child; caregiver’s age; caregiver’s education; child’s age; “Has the child ever been afraid of other children?”; “Have other children bullied or threatened the child?”; “Has the child ever felt discomfort when chewing?”; CP; ID. OHRQoL: oral health-related quality of life; CI: confidence interval; ASD: autism spectrum disorder; CP: cerebral palsy; ADHD: attention deficit hyperactivity disorder; ODD: oppositional defiant disorder; ID: intellectual disability.

Bullying

Present

103 (78.6)

98 (95.1)

5 (4.9)

0.669

1.025 (0.916 - 1.146)

Absent

28 (21.4)

26 (92.9)

2 (7.1)

1.00

Dental caries

Yes

93 (71)

88 (94.6)

5 (5.4)

0.979

0.999 (0.914 - 1.092)

38 (29)

36 (94.7)

2 (5.3)

1.00

Orthodontic treatment need

Yes

78 (63.4)

75 (96.2)

3 (3.8)

0.516

1.030 (0.942 - 1.127)

45 (36.6)

42 (93.3)

3 (6.7)

1.00

Caregiver bond

Relatives (grandmother/aunt)

21 (15.9)

21 (100)

0 (0)

0.046^a

1.041 (1.001 - 1.083)

Father

10 (7.6)

7 (70)

3 (30)

0.128

0.729 (0.485 - 1.096)

Mother

101 (76.5)

97 (96)

4 (4)

1.00

Caregiver’s age

Middle-aged or elderly adults (≥ 45 years)

40 (30.3)

39 (97.5)

1 (2.5)

0.260

1.043 (0.969 - 1.122)

Young adults (18 - 44 years)

92 (69.7)

86 (93.5)

6 (6.5)

1.00

Time spent with child

Less than 12 h a day

8 (6.1)

8 (100)

0 (0)

0.157

1.032 (0.988 - 1.077)

> 12 and < 18 h a day

59 (44.7)

54 (91.5)

5 (8.5)

0.207

0.944 (0.864 - 1.032)

≥ 18 to 24 h a day

65 (49.2)

63 (96.9)

2 (3.1)

1.00

Caregiver’s education

> High school

18 (13.6)

17 (94.4)

1 (5.6)

0.502

0.961 (0.855 - 1.080)

> Primary education to ≤ high school

55 (41.7)

50 (90.9)

5 (9.1)

0.089

0.925 (0.845 - 1.012)

Primary education or less

59 (44.7)

58 (98.3)

1 (1.7)

1.00

Family income

Equal or more than 3 minimum wages

25 (18.9)

24 (96)

1 (4)

0.317

0.960 (0.866 - 1.040)

Between 1 and less than 3 minimum wages

79 (59.8)

73 (92.4)

6 (7.6)

0.014^a

0.924 (0.867 - 0.984)

Less than 1 minimum wage

28 (21.2)

28 (100)

0 (0)

1.00

Child’s sex

Male

89 (67.4)

83 (93.3)

6 (6.7)

0.211

0.955 (0.888 - 1.027)

Female

43 (32.6)

42 (97.7)

1 (2.3)

1.00

Child’s age

Between 11 and 14 years

55 (41.7)

50 (90.9)

5 (9.1)

0.138

0.933 (0.852 - 1.022)

Between 6 and 10 years

77 (58.3)

75 (97.4)

2 (2.6)

1.00

Child’s ethnicity

Non-White (Hispanic/African)

37 (28)

36 (97.3)

1 (2.7)

0.322

1.039 (0.964 - 1.119)

White (Caucasian)

95 (72)

89 (93.7)

6 (6.3)

1.00

Child’s living arrangement

Relatives (grandmother, uncles, brothers)

20 (15.2)

20 (100)

0 (0)

0.008^a

1.067 (1.017 - 1.119)

Parents

112 (84.8)

105 (93.8)

7 (6.3)

1.00

Dental caries treatment history

Yes

75 (57.3)

72 (96)

3 (4)

0.449

1.034 (0.949 - 1.127)

56 (42.7)

52 (92.9)

4 (7.1)

1.00

Fear of other children

Yes

59 (45.4)

55 (93.2)

4 (6.8)

0.530

0.973 (0.895 - 1.059)

71 (54.6)

68 (95.8)

3 (4.2)

1.00

Experience of peer teasing

Yes

89 (70.1)

85 (95.5)

4 (4.5)

0.492

1.037 (0.935 - 1.150)

38 (29.9)

35 (92.1)

3 (7.9)

1.00

Experience of peer bullying

Yes

52 (40.3)

51 (98.1)

1 (1.9)

0.108

1.064 (0.987 - 1.147)

77 (59.7)

71 (92.2)

6 (7.8)

1.00

Orthodontic appliance use

Yes

9 (6.8)

9 (100)

0 (0)

0.008^a

1.060 (1.015 - 1.107)

123 (93.2)

116 (94.3)

7 (5.7)

1.00

Chewing discomfort

Yes

47 (35.9)

46 (97.9)

1 (2.1)

0.157

1.054 (0.980 - 1.134)

84 (64.1)

78 (92.9)

6 (7.1)

1.00

ASD

Yes

40 (30.3)

37 (92.5)

3 (7.5)

0.505

0.967 (0.876 - 1.067)

92 (69.7)

88 (95.7)

4 (4.3)

1.00

Epilepsy

Yes

65 (49.2)

62 (95.4)

3 (4.6)

0.728

1.014 (0.936 - 1.100)

68 (50.8)

63 (94)

4 (6)

1.00

Yes

19 (14.4)

19 (100)

0 (0)

0.008^a

1.066 (1.017 - 1.118)

0.008^a

1.066 (1.017-1.118)

113 (85.6)

106 (93.8)

7 (6.2)

1.00

ODD

Yes

6 (4.5)

6 (100)

0 (0)

0.008^a

1.059 (1.015 - 1.105)

126 (95.5)

119 (94.4)

7 (5.6)

1.00

ADHD

Yes

35 (26.5)

33 (94.3)

2 (5.7)

0.902

0.994 (0.905 - 1.092)

97 (73.5)

92 (94.8)

5 (5.2)

1.00

Yes

25 (18.9)

22 (88)

3 (12)

0.239

0.914 (0.787 - 1.062)

107 (81.1)

103 (96.3)

4 (3.7)

1.00

↓ **Table 2.** Prevalence of Negative Impacts on OHRQoL and Descriptive Statistics of P-CPQ Total and Domain Scores
Domains	Mean score ± SD	Confidence interval	Minimum - maximum	Median ± IQR	Possible range	Observed range
OHRQoL: oral health-related quality of life; P-CPQ: Parent-Caregiver Perception Questionnaire; SD: standard deviation; IQR: interquartile range.
Oral symptoms domain	2.35 ± 2.69	1.88 - 2.81	0 - 12	2 ± 4	0 - 12	0 - 12
Functional limitations domain	5.56 ± 4.00	4.87 - 6.25	0 - 16	5 ± 6	0 - 16	0 - 16
Emotional wellbeing domain	3.02 ± 3.22	2.46 - 3.57	0 - 12	2 ± 5	0 - 12	0 - 12
Social wellbeing domain	1.55 ± 2.79	1.07 - 2.04	0 - 12	0 ± 2	0 - 12	0 - 12
P-CPQ total score	12.48 ± 9.39	10.85 - 14.10	0 - 46	10 ± 13	0 - 52	0 - 46

↓ Table 2. Prevalence of Negative Impacts on OHRQoL and Descriptive Statistics of P-CPQ Total and Domain Scores

Domains

Mean score ± SD

Confidence interval

Minimum - maximum

Median ± IQR

Possible range

Observed range

OHRQoL: oral health-related quality of life; P-CPQ: Parent-Caregiver Perception Questionnaire; SD: standard deviation; IQR: interquartile range.

Oral symptoms domain

2.35 ± 2.69

1.88 - 2.81

0 - 12

2 ± 4

0 - 12

Functional limitations domain

5.56 ± 4.00

4.87 - 6.25

0 - 16

5 ± 6

0 - 16

Emotional wellbeing domain

3.02 ± 3.22

2.46 - 3.57

0 - 12

2 ± 5

0 - 12

Social wellbeing domain

1.55 ± 2.79

1.07 - 2.04

0 - 12

0 ± 2

0 - 12

P-CPQ total score

12.48 ± 9.39

10.85 - 14.10

0 - 46

10 ± 13

0 - 52

0 - 46

↓ **Table 3.** Spearman’s Correlation Coefficients Between P-CPQ Total Score and Its Domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, and Social Well-Being)
Domains	Correlation coefficient (r)	P value
*Spearman’s correlation; P < 0.05 indicates statistical significance. P-CPQ: Parent-Caregiver Perception Questionnaire.
Oral symptoms domain (Q1 - 3)	0.621*	P < 0.001
Functional limitations domain (Q4 - 7)	0.780*	P < 0.001
Emotional wellbeing domain (Q8 - 10)	0.745*	P < 0.001
Social well-being domain (Q11 - 13)	0.618*	P < 0.001
Functional limitations ↔ emotional wellbeing	0.764*	P < 0.001
Functional limitations ↔ social well-being	0.681*	P < 0.001
Emotional wellbeing ↔ social well-being	0.685*	P < 0.001

↓ Table 3. Spearman’s Correlation Coefficients Between P-CPQ Total Score and Its Domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, and Social Well-Being)

Domains

Correlation coefficient (r)

P value

*Spearman’s correlation; P < 0.05 indicates statistical significance. P-CPQ: Parent-Caregiver Perception Questionnaire.

Oral symptoms domain (Q1 - 3)

0.621*

P < 0.001

Functional limitations domain (Q4 - 7)

0.780*

P < 0.001

Emotional wellbeing domain (Q8 - 10)

0.745*

P < 0.001

Social well-being domain (Q11 - 13)

0.618*

P < 0.001

Functional limitations ↔ emotional wellbeing

0.764*

P < 0.001

Functional limitations ↔ social well-being

0.681*

P < 0.001

Emotional wellbeing ↔ social well-being

0.685*

P < 0.001